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Path Y > Histopathology - Upper GI disease > Flashcards

Histopathology - Upper GI disease Flashcards

1
Q

What is the “Z line” in the GI tract?

A

Normal appearance of squamo-columnar junction (epithelium transitions from squamous to columnar)

Z line in the oesophagus is the term for a faint zig-zag impression at the gastro-oesophageal junction that demarcates the transition between the stratified squamous epithelium in the oesophagus and the intestinal epithelium of the gastric cardia (the squamocolumnar junction)

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2
Q

Where is the cardia portion of the stomach?

A

Junction between oesophagus and stomach

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3
Q

What are the 3 layers of the stomach wall?

A 
Gastric mucosa (columnar) 
Lamina propria (containing glands) 
Muscularis mucosa
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4
Q

In a normal duodenum, what is the villous:crypt ratio?

A

3:1

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5
Q

Where are goblet cells usually found?

A

Intestine

(NOT in stomach)

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6
Q

What is the most common cause of acute oesophagitis?

A

GORD

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7
Q

If reflux oesophagitis causes a perforation of the oesophagus, what will be the result?

A

Mediastinitis

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8
Q

What are the 4 most common complications to remember of most GI pathologies?

A

Ulceration
Haemorrhage
Perforation
Stricture

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9
Q

What is gastric metaplasia?

A

type of CLO without goblet cels
Metaplastic change in oesophagus WITHOUT goblet cells

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10
Q

What is intestinal type metaplasia?

A

type of CLO with goblet cells
Replacement of squamous epithelium with metaplastic columnar epithelium WITH goblet cells present
higher cancer risk in this type

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11
Q

What is the most common sequence of pathological progression to cancer in the upper GIT?

A

Metaplasia –> dysplasia –> Cancer

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12
Q

What is the most common type of oesophageal cancel?

A

Adenocarcinoma

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13
Q

Where does adenocarcinoma of the oesophagus usually develop?

A

bottom 1/3 of oesophagus

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14
Q

Which type of oesophageal cancer is most strongly associated with GORD & Barrett’s?

A

Adenocarcinoma

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15
Q

What is the most common type of oesophageal cancer in developing coutries?

A

Squamous cell carcinoma

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16
Q

Which type of oesophageal cancer is most associated with smoking and alcohol?

A

Squamous cell carcinoma

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17
Q

Where in the oesophagus does squamous cell carcinoma tend to present?

A

upper 2/3 of oesophagus

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18
Q

Why is prognosis for oesophageal carcinoma particularly poor?

A

Most patients are not suitable for resection surgery

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19
Q

What other condition are oesophageal varices particularly associated with?

A

Portal vein stenosis/hypertenion

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20
Q

What are the 3 main causes of acute gastritis?

A

Aspirin/NSAIDs
Alcohol
H pylori

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21
Q

What are the 4 major causes of chronic gastritis? Where do they affect in stomach

A

ABCDs of chronic gastritis
Autoimmune (antiparietal cell antibodies affects body)
Bacterial (H pylori, affects antrum)
Chemical (NSAIDs, bile reflux, affects antrum)
D = IBD

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22
Q

Which types of neoplasm is H pylori associated with?

A

Adenocarcinoma
Lymphoma (MALToma)

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23
Q

How do some H pylori inject toxin into the mucosa?

A

Via cag A needle appendage (Cad A +ve h pylori have this)

(as they can’t directly invade epithelium)

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24
Q

Which strain of H pylori is associated with more aggressive chronic gastritis?

A

cag-A positive

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25
Q

Why might you biopsy a gastric ulcer?

A

ALL gastric ulcers should be biopsied to exclude malignancy

26
Q

What will be the result of a perforated gastric ulcer?

A

Peritonitis

27
Q

What is gastric epithelial dysplasia?

A

Abnormal epithelial pattern of growth but no BMembrane invasion

28
Q

What is the key cytological feature of gastric epithelial dysplasia?

A

High nuclear cytoplasmic ratio

29
Q

What is the difference between gastric dysplasia and gastric cancer?

A

Invasion of basement membrane

30
Q

What type of carcinoma is the most common type of gastric cancer?

A

Adenocarcinoma - 95%

31
Q

Where is gastric cancer most common?

A

Japan, by far

32
Q

What are the morphological categories of gastric cancer(specifically adenocarcinoma)?

A

Intestinal
Diffuse aka signet ring = poor prognosis

33
Q

What is the pattern of intestinal gastric adenocarcinoma?

A

Well-differentiated (mucin containing glands)

34
Q

What is the pattern of diffuse gastric adenocarcinoma?

A

Poorly differentiated
Signet ring cells, Linitis plastica

35
Q

What is linitis plastica?

A

No focal lesion in stomach, but whole thing is thickened and static - due to diffuse adenocarcinoma

36
Q

What is a gastrointestinal stromal tumour? (GIST)

A

Tumour of the interstitial cells of Cajal in the stomach - a SARCOMA

37
Q

What is the cause of gastric MALToma?

A

Chronic inflammation, usually due to H pylori

38
Q

What are gastric MALTomas composed of?

A

B cells

39
Q

What is the first-line treatment of gastric MALToma?

A

H pylori treatment, could reverse lymphoma

40
Q

Which type of gastrointestinal tract ulcers are always benign?

A

Duodenal

41
Q

What is cryptosporidiosis?

A

Protozoal GIT infection causing diarrhoea seen in immunosuppressed patients

42
Q

Where does giardia lamblia infection cause pathology?

A

Villi of GIT

43
Q

What is the route of transmission of giardia?

A

Faeco/oral route

44
Q

what cell damages villi in coeliac disease?

A

Cytotoxic T cells

45
Q

In what condition are increased numbers of intraepithelial lymphocytes in the GIT seen?

A

Coeliac

46
Q

What are the 3 main histological features of coeliac?

A

Crypt hyperplasia
Villous atrophy
Increased numbers of intraepithelial lymphocytes

47
Q

Which two antibodies are required for diagnosis of coeliac disease?

A 
Endomysial 
Tissue transglutaminase (TTG)
48
Q

Where is MALToma associated with coeliac likely to be located?

A

Duodenum

49
Q

What is the type of MALToma as a result of coeliac disease called?

A

Enteropathy associated T cell lymphoma

50
Q

distinguish between ulcer and erosion

A

ulcer past muscularis mucosa (into submucosa)
erosion before muscualris mucosa (not into submucosa)

51
Q

define barrett’s oesophagus

A

metaplastic process where squamous epithelium of lower oesophagus are replaced by columnar epithelium
aka columnar lined epithelium

52
Q

metaplasia vs dysplasia

A

Metaplasia: Transforms a cell from one form to another; caused by external stimulus; can be reversible; less likely to lead to cancer. Dysplasia: Transforms a cell into an abnormal version of itself; caused by internal stimulus; is not reversible; more likely to lead to cancer.

53
Q

compare the histology of SCC of oesophagus and adenocarcinoma

A

SCC - invades submucosa, cells form keratin
adenocarcinoma - glandular epithelium, mucin

54
Q

which cells are involved in acute vs chronic gastritis

A 
acute = neutrophils 
chronic = lymphocytes
55
Q

define malt. what do you see on stomach biopsy

A

lymphoma associated lymphoid tissue
= chronic gastritis associated w h pylori
biopsy - lymphoid follicles = highly suggestive of H pylori as not normal

56
Q

what cancers do atrophic vs non-atrophic gastritis progress to

A 
atrophic = adenocarcinoma 
non-atrophic = MALToma
57
Q

antrum predominant gastritis progresses to?

A

duodenal ulcer

58
Q

outline the 2 pathways that lead to GI cancers

A

metaplasia-dysplasia pathway = upper GI e.g oesophageal cancer
adenoma-carcinoma pathway = lower GI e.g colon cancer

59
Q

give an example of a neuroendocrine tumour of the stomach. what condition is this seen in sometimes

A

Zollinger Ellison syndrome
a condition in which a gastrin-secreting tumour or hyperplasia of the islet cells in the pancreas causes overproduction of gastric acid, resulting in recurrent peptic ulcers.
25% time linked to MEN1

60
Q

overall survival rate of gastric cancer

A

15%

61
Q

what 3 histological changes are seen in coeliac disease

A 
villous atrophy (flat villi) 
crypt hyperplasia 
increases intraepithelial lymphocytes
62
Q

give the diagnostic criteria of coeliac disease

A

endomysial antibodies - anti EMA
tissue transglutaminase antibodies - anti TTG
AND a biopsy
on gluten rich diet showing villous atrophy
off gluten rich diet showing normal villi

Path Y (81 decks)

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